That whirring you hear may be the sound of a health care finance executive’s heads spinning in circles.

The Patient Protection and Affordable Care Act of 2010 (PPACA) and other federal laws and regulations have given those executives a to-do list that reaches to Mars, just as it has given health insurance company executives a to-do list that reaches to Jupiter, and it’s not always clear which items on the list should come first.

Firstsource Solutions Ltd., Mumbai, India (NYSE:FSL) — a company that hopes to profit by taking on part of the mountain of the information technology (IT) work and other back-office health care organizations will have to do — recently conducted an informal survey of the health care finance executives who attended a conference in Las Vegas.

Firstsource found that 49% said developing accountable care organization (ACO) relationships should be the top priority under health care reform efforts. Another 27% simplifying financial and administrative processes ought to be the top health care reform IT priority, and 24% said improving information technology infrastructure should be the top priority.

On the one hand: Technology is good!

On the other hand: Er … how are the ACOs supposed to succeed with second-rate infrastructure?

The ACO is supposed to be an organization that gives primary care doctors, specialists, hospitals and others a financial incentive to care for a patient on a whole-patient basis, by tying part of the ACO team’s pay on the quality and efficiency of the care the patient received.

An ACO is supposed to, for example, offer provider-based wellness and condition management programs and identify patients who need extra attention before they start running up big, preventable bills.

The group practices that worked with health maintenance organizations (HMOs) in the 1980s and 1990s were supposed to do something like that, too, but they failed, partly because they lacked the technology and data to figure out how much risk they were actually taking and promising to take.

It health care organizations go into ACOs with rickety computers, that will work out better because … ?

On the third hand: Maybe the whole point of health care reform is to crash the health care and health finance systems so badly that they break down entirely and we have to replace them with something else. Maybe Congress didn’t have the heart to just put those health care and health finance systems we’ve spent so much on out on the global curb, so it’s killing them off by letting them kill themselves instead of offering them to a good home on Freecycle.

I can relate.

Maybe the conversation shouldn’t be, “What computers will everyone need for PPACA and the ACOs and the ICD-10 shift and all that?”, but, “What computers will everyone need when they get serious about the real health reform effort, whatever that will look like and whenever it will start?”